SafeUseofOpioidsConcurrentPrescribingFHIR
type: Measure
node role: treeRoot
id:
  v: SafeUseofOpioidsConcurrentPrescribingFHIR
meta:
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm
    l: computable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm
    l: publishable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm
    l: executable-measure-cqfm
text:
  status:
    v: extensions
  div:
    v: Title: Safe Use of Opioids - Concurrent PrescribingFHIR Id: SafeUseofOpioidsConcurrentPrescribingFHIR Download cql: SafeUseofOpioidsConcurrentPrescribingFHIR.cql Version: 0.1.000 Url: Safe Use of Opioids - Concurrent PrescribingFHIR short-name identifier: CMS506FHIR version-independent identifier: urn:uuid:95d529af-66b4-4cfd-bc1f-f43704dc47ad version-specific identifier: urn:uuid:4adc0abd-6de0-42e7-ab1a-37f53d3ddd1f endorser (NQF) identifier: 3316e publisher (CMS) identifier: 506FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-08-17 18:49:02+0000 Approval Date: 2023-08-18 Last Review Date: 2023-08-18 Name: SafeUseofOpioidsConcurrentPrescribingFHIR Publisher: Centers for Medicare & Medicaid Services (CMS) Author: Mathematica: https://www.mathematica.org/ Description: Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge Use Context: code value program Purpose: UNKNOWN Copyright: Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved. Disclaimer: These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATION ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND. Due to technical…
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/medicationrequest-category
        l: medicationrequest-category
      code:
        v: community
      display:
        v: Community
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/medicationrequest-category
        l: medicationrequest-category
      code:
        v: discharge
      display:
        v: Discharge
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-category
        l: condition-category
      code:
        v: problem-list-item
      display:
        v: Problem List Item
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/us/core/CodeSystem/condition-category
        l: condition-category
      code:
        v: health-concern
      display:
        v: Health Concern
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: active
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: recurrence
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: relapse
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SupplementalDataElements
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SafeUseofOpioidsConcurrentPrescribingFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": SDE."SDE Sex"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: CQMCommon
    extension:
      url:
        v: name
        l: name
      value: String
        v: Inpatient Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Inpatient Encounter": [Encounter: "Encounter Inpatient"] EncounterInpatient where EncounterInpatient.status = 'finished' and EncounterInpatient.period ends during day of "Measurement Period"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SafeUseofOpioidsConcurrentPrescribingFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Inpatient Encounter with Age Greater than or Equal to 18
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Inpatient Encounter with Age Greater than or Equal to 18": CQMCommon."Inpatient Encounter" InpatientHospitalEncounter where AgeInYearsAt(date from start of InpatientHospitalEncounter.period) >= 18

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 3

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Opioid at Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Opioid at Discharge": ( [MedicationRequest: "Schedule II & III Opioid Medications"] OpioidMedications where ( OpioidMedications.isCommunity ( ) or OpioidMedications.isDischarge ( ) ) ) OpioidDischargeMedication where OpioidDischargeMedication.status in { 'active', 'completed' } and OpioidDischargeMedication.intent = 'order'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 4
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Benzodiazepine at Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Benzodiazepine at Discharge": ( [MedicationRequest: medication in "Schedule IV Benzodiazepines"] BenzoMedications where ( BenzoMedications.isCommunity ( ) or BenzoMedications.isDischarge ( ) ) ) BenzodiazepineDischargeMedication where BenzodiazepineDischargeMedication.status in { 'active', 'completed' } and BenzodiazepineDischargeMedication.intent = 'order'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 5
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator": /*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.*/ ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter where ( Count("Opioid at Discharge" Opioids return distinct Opioids.medication ) >= 2 ) ) union ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter with "Opioid at Discharge" OpioidsDischarge such that OpioidsDischarge.authoredOn during InpatientEncounter.period with "Benzodiazepine at Discharge" BenzodiazepinesDischarge such that BenzodiazepinesDischarge.authoredOn during day of InpatientEncounter.period )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Inpatient Encounters with an Opioid or Benzodiazepine at Discharge
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge": "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter with ( "Opioid at Discharge" union "Benzodiazepine at Discharge" ) OpioidOrBenzodiazepineAtDischarge such that OpioidOrBenzodiazepineAtDischarge.authoredOn during day of InpatientEncounter.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": "Initial Population"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": SDE."SDE Payer"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": SDE."SDE Ethnicity"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Intervention Palliative or Hospice Care
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Intervention Palliative or Hospice Care": [ServiceRequest: "Palliative or Hospice Care"] union [Procedure: "Palliative or Hospice Care"]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusion
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusion": /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/ "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter where exists ( [Condition: "All Primary and Secondary Cancer"] Cancer where ( Cancer.isProblemListItem ( ) or Cancer.isHealthConcern ( ) ) and Cancer.isActive ( ) and Cancer.prevalenceInterval ( ) overlaps InpatientEncounter.period ) or exists ( ( InpatientEncounter.encounterDiagnosis ( ) ) InpatientEncounterDiagnosis where InpatientEncounterDiagnosis.code in "All Primary and Secondary Cancer" ) or exists ( "Intervention Palliative or Hospice Care" PalliativeOrHospiceCare where Coalesce(PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn.toInterval()) during day of CQMCommon."HospitalizationWithObservation" ( InpatientEncounter ) ) or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility" or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission" or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SafeUseofOpioidsConcurrentPrescribingFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": SDE."SDE Race"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library SDE
resource:
  v: Library/SupplementalDataElements|3.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements

type:
  v: depends-on
display:
  v: Library CQMCommon
resource:
  v: Library/CQMCommon|1.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/CQMCommon

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library QICoreCommon
resource:
  v: Library/QICoreCommon|1.5.000
  l: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library QICoreCommon
resource:
  v: Library/QICoreCommon|1.5.000
  l: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon

type:
  v: depends-on
display:
  v: Code system MedicationRequestCategory
resource:
  v: http://terminology.hl7.org/CodeSystem/medicationrequest-category
  l: medicationrequest-category

type:
  v: depends-on
display:
  v: Code system ConditionCategory
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-category
  l: condition-category

type:
  v: depends-on
display:
  v: Code system USCoreConditionCategoryExtensionCodes
resource:
  v: http://hl7.org/fhir/us/core/CodeSystem/condition-category
  l: condition-category

type:
  v: depends-on
display:
  v: Code system ConditionClinicalStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-clinical
  l: condition-clinical

type:
  v: depends-on
display:
  v: Value set Encounter Inpatient
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: depends-on
display:
  v: Value set Schedule II & III Opioid Medications
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.165
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.165

type:
  v: depends-on
display:
  v: Value set Schedule IV Benzodiazepines
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1

type:
  v: depends-on
display:
  v: Value set Payer Type
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: depends-on
display:
  v: Value set All Primary and Secondary Cancer
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.161
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.161

type:
  v: depends-on
display:
  v: Value set Palliative or Hospice Care
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1579
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1579

type:
  v: depends-on
display:
  v: Value set Observation Services
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

type:
  v: depends-on
display:
  v: Value set Emergency Department Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

type:
  v: depends-on
display:
  v: Value set Discharge To Acute Care Facility
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87

type:
  v: depends-on
display:
  v: Value set Hospice Care Referral or Admission
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1116.365
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1116.365

type:
  v: depends-on
display:
  v: Value set Patient Expired
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309

name:
  v: Measurement Period
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: Period

name:
  v: SDE Sex
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Coding

name:
  v: Numerator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Denominator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Payer
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Initial Population
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Ethnicity
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

name:
  v: Denominator Exclusion
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Race
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/Patient
  l: Patient
must support:
  v: gender
must support:
  v: gender.value
must support:
  v: birthDate
must support:
  v: birthDate.value

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.165
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.165

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.165
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.165

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication
must support:
  v: status
must support:
  v: status.value
must support:
  v: intent
must support:
  v: intent.value
must support:
  v: authoredOn
must support:
  v: authoredOn.value
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
  l: qicore-medicationrequest
must support:
  v: medication
must support:
  v: status
must support:
  v: status.value
must support:
  v: intent
must support:
  v: intent.value
must support:
  v: authoredOn
must support:
  v: authoredOn.value
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1125.1

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: Coverage
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
  l: qicore-coverage
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: uri
profile:
  v: http://hl7.org/fhir/uri
  l: uri
must support:
  v: value

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: url
must support:
  v: extension

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: url
must support:
  v: extension

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/Condition
  l: Condition
must support:
  v: clinicalStatus

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: id
must support:
  v: id.value

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest
  l: qicore-servicerequest
must support:
  v: code
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1579
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1579

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
  l: qicore-procedure
must support:
  v: code
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1579
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1579

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.161
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.161

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: url
must support:
  v: extension

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: url
must support:
  v: extension

type:
  v: Coverage
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
  l: qicore-coverage
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: url
must support:
  v: extension

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: url
must support:
  v: extension

id:
  v: supplementalDataGuidance
extension:
  url:
    v: guidance
    l: guidance
extension:
  url:
    v: usage
    l: usage
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-data-usage
        l: measure-data-usage
      code:
        v: supplemental-data
      display:
        v: Supplemental Data
    text:
      v: Supplemental Data Guidance
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance
  l: cqfm-supplementalDataGuidance

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements
  l: cqfm-effectiveDataRequirements
value: Reference
  l: effective-data-requirements
  reference:
    v: #effective-data-requirements

use:
  v: usual
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: short-name
system:
  v: https://madie.cms.gov/measure/shortName
  l: shortName
value:
  v: CMS506FHIR

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: version-independent
system:
  v: urn:ietf:rfc:3986
  l: 3986

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: version-specific
system:
  v: urn:ietf:rfc:3986
  l: 3986

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: endorser
system:
  v: https://madie.cms.gov/measure/nqfId
  l: nqfId
value:
  v: 3316e
assigner:
  display:
    v: NQF

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: publisher
system:
  v: https://madie.cms.gov/measure/cmsId
  l: cmsId
value:
  v: 506FHIR
assigner:
  display:
    v: CMS

v: 0.1.000

v: SafeUseofOpioidsConcurrentPrescribingFHIR

v: Safe Use of Opioids - Concurrent PrescribingFHIR

v: draft

v: false

v: 2023-08-17T18:49:02+00:00

v: Centers for Medicare & Medicaid Services (CMS)

telecom:
  system:
    v: url
  value:
    v: https://www.cms.gov/

v: Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: program
value: CodeableConcept
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs
      l: quality-programs
    code:
      v: eh-cah
    display:
      v: EH/CAH

v: UNKNOWN

v: Clinician judgement, clinical appropriateness, or both may indicate concurrent prescribing of two unique opioids or an opioid and benzodiazepine is medically necessary, thus the measure is not expected to have a zero rate. Inpatient hospitalizations with discharge medications of a new or continuing opioid or a new or continuing benzodiazepine prescription should be included in the initial population. Inpatient hospitalizations with discharge medications of two or more new or continuing opioids or new or continuing opioid and benzodiazepine resulting in concurrent therapy at discharge should be included in the numerator. Each benzodiazepine and opioid included on the medication discharge list is considered a unique prescription. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS506v6. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).

v: Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.

v: 2023-08-18

v: 2023-08-18

start:
  v: 2024-01-01
end:
  v: 2024-12-31

name:
  v: Mathematica
telecom:
  system:
    v: url
  value:
    v: https://www.mathematica.org/

v: These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATION ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

v: Unintentional opioid overdose fatalities have become a major public health concern in the United States (Rudd et al., 2016). Reducing the number of unintentional overdoses has become a priority for numerous federal organizations including, but not limited to, the Centers for Disease Control and Prevention (CDC), the Federal Interagency Workgroup for Opioid Adverse Drug Events, and the Substance Abuse and Mental Health Services Administration. Concurrent prescriptions of opioids or opioids and benzodiazepines places patients at a greater risk of unintentional overdose due to the increased risk of respiratory depression (Dowell, Haegerich, & Chou, 2016 and Dowell, Ragan, Jones, Baldwin, & Chou, 2022). An analysis of national prescribing patterns shows that more than half of patients who received an opioid prescription in 2009 had filled another opioid prescription within the previous 30 days (National Institute on Drug Abuse, 2011). Studies of multiple claims and prescription databases have shown that between 5%-15% of patients receive concurrent opioid prescriptions and 5%-20% of patients receive concurrent opioid and benzodiazepine prescriptions across various settings (Liu et al., 2013; Mack et al., 2015, Park et al., 2015). Patients who have multiple opioid prescriptions have an increased risk for overdose (Jena et al., 2014). Rates of fatal overdose are ten times higher in patients who are co-dispensed opioid analgesics and benzodiazepines than opioids alone (Dasgupta et al., 2015). The number of opioid overdose deaths involving benzodiazepines increased 14% on average each year from 2006 to 2011, while the number of opioid analgesic overdose deaths not involving benzodiazepines did not change significantly (Jones & McAninch, 2015). Furthermore, concurrent use of benzodiazepines with opioids was prevalent in 31%-51% of fatal overdoses (Dowell, Haegerich, & Chou, 2016). One study found that eliminating concurrent use of opioids and benzodiazepines could reduce the…

v: The CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 recommends that clinicians should: - “[Use strategies minimizing] opioid use…for both opioid-naïve and opioid-tolerant patients with acute pain when possible. If patients receiving long-term opioid therapy require additional medication for acute pain, nonopioid medications should be used when possible.” - ”Use particular caution when prescribing opioid pain medication and benzodiazepines concurrently." - “Review increased risks for respiratory depression when opioids are taken with benzodiazepines, other sedatives, alcohol, nonprescribed or illicit drugs (e.g., heroin), or other opioids (see Recommendations 8 and 11)” - “Closely monitor patients who are unable to taper and who continue on high-dose or otherwise high-risk opioid regimens (e.g., opioids prescribed concurrently with benzodiazepines) and should work with patients to mitigate overdose risk (e.g., by providing overdose education and naloxone) (see Recommendation 8).” - "Discuss information from the PDMP with the patient and confirm that the patient is aware of any additional prescriptions.” - “Discuss safety concerns, including increased risk for respiratory depression and overdose, with patients found to be receiving overlapping prescription opioids from multiple clinicians who are not coordinating the patient’s care or patients who are receiving medications that increase risk when combined with opioids (e.g., benzodiazepines) (see Recommendation 11), and offer naloxone (see Recommendation 8). - "Discuss safety concerns with other clinicians who are prescribing controlled substances for the patient. Ideally, clinicians should first discuss concerns with the patient and inform them that they plan to coordinate care with their other clinicians to improve the patient’s safety.” In addition to the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain, opioid prescribing guidelines issued by various stat…

id:
  v: 64345d297c12bd4a0fdf28b2
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring
    l: cqfm-scoring
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-scoring
        l: measure-scoring
      code:
        v: proportion
      display:
        v: Proportion
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
    l: cqfm-populationBasis
  value: Code
    v: Encounter
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type
    l: cqfm-type
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-type
        l: measure-type
      code:
        v: process
      display:
        v: Process
description:
  v: Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge.
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  description:
    v: Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed one or more new or continuing opioid or benzodiazepine at discharge
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator
      display:
        v: Denominator
  description:
    v: Initial Population
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  description:
    v: Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are ordered or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the hospitalization or in an emergency department encounter or observation stay immediately prior to hospitalization, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay.
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exclusion
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  description:
    v: Inpatient hospitalizations where the patient is prescribed or continuing to take two or more opioids or an opioid and benzodiazepine at discharge
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator-exclusion
      display:
        v: Numerator Exclusion
  criteria:
    language:
      v: text/cql-identifier
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exception
      display:
        v: Denominator Exception
  criteria:
    language:
      v: text/cql-identifier

id:
  v: sde-ethnicity
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Ethnicity
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Ethnicity

id:
  v: sde-payer
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Payer
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Payer

id:
  v: sde-race
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Race
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Race

id:
  v: sde-sex
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Sex
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Sex